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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Monitoring testosterone replacement therapy with transdermal gel: when and how?
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<blockquote data-quote="madman" data-source="post: 153104" data-attributes="member: 13851"><p><strong>Abstract </strong></p><p></p><p><strong><span style="color: rgb(184, 49, 47)">Purpose </span></strong></p><p>Testosterone replacement therapy (TRT) is recommended for the treatment of most cases of male hypogonadism. Transdermal testosterone (T) gels are commonly used in clinical practice; however, there is little evidence concerning how to monitor dosage to bring and maintain serum T levels in the normal physiologic range.</p><p></p><p><strong><span style="color: rgb(184, 49, 47)">Methods </span></strong></p><p>We examined 30 hypogonadal patients undergoing treatment with 40 mg/day transdermal 2% testosterone gel. After a week from treatment onset, all patients underwent a total of four measurements to assess serum total T, bioavailable T and free T at +2 h (samples A and A′) and +23 h (samples B and B′).</p><p></p><p><strong><span style="color: rgb(184, 49, 47)">Results </span></strong></p><p><span style="color: rgb(147, 101, 184)"><strong>No significant difference was found concerning total, free and bioavailable T between the two samples taken at the same time points (A vs A′ and B vs B′).</strong></span> <span style="color: rgb(44, 130, 201)"><strong>A repeated-measures mixed effects regression model showed significantly lower serum levels of total, free and bioavailable T at +23 h compared to +2 h (total T, β=−3.050±0.704, p<0.001; free T, β=−85.187±22.746, p<0.001; bioavailable T, β=−1.519±0.497, p=0.003) without a significant between-sample variability. </strong></span><strong><span style="color: rgb(26, 188, 156)">Serum T>3.5 ng/ml at +2 h was reached in 21/30 patients (70%), but only 11 (36.7%) still had adequate serum T at +23 h. </span></strong></p><p></p><p><strong><span style="color: rgb(184, 49, 47)">Conclusion </span></strong></p><p><strong><span style="color: rgb(44, 130, 201)">Assessment of TRT with transdermal gels at its peak and at its minimum could be useful in providing a finely tailored treatment for hypogonadal men, both preventing supra-physiological levels and maintaining adequate concentrations through the day.</span></strong></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p><strong>Conclusions </strong></p><p><span style="color: rgb(184, 49, 47)"><strong>The treatment of male hypogonadism is associated with improvements in several health outcomes, ranging from sexual symptoms to metabolic profile.</strong></span> Most patients undergo TRT; transdermal testosterone gels are often preferred by patients due to their ease of use and allow for quick treatment discontinuation if needed. Monitoring of hypogonadism is necessary, as TRT should increase serum testosterone without reaching supra-physiological levels; <span style="color: rgb(44, 130, 201)"><strong>guidelines suggest assessing “peak” concentration, although we hypothesize that assessment of serum T at its lowest point—just before a new gel application—could be useful in assessing the correctness of the treatment dosage.</strong></span> <span style="color: rgb(26, 188, 156)"><strong>In the authors’ opinion, if only one measurement is feasible, the “lowest-point” measurement could be helpful in patients with no improvement despite treatment, whereas the “peak” measurement providing useful safety information remains a priority in all other patients.</strong></span> While two measurements are necessary for diagnosis, the little intra-individual variation could spare the necessity of a second measurement for subjects undergoing treatment with testosterone transdermal gels.</p></blockquote><p></p>
[QUOTE="madman, post: 153104, member: 13851"] [B]Abstract [/B] [B][COLOR=rgb(184, 49, 47)]Purpose [/COLOR][/B] Testosterone replacement therapy (TRT) is recommended for the treatment of most cases of male hypogonadism. Transdermal testosterone (T) gels are commonly used in clinical practice; however, there is little evidence concerning how to monitor dosage to bring and maintain serum T levels in the normal physiologic range. [B][COLOR=rgb(184, 49, 47)]Methods [/COLOR][/B] We examined 30 hypogonadal patients undergoing treatment with 40 mg/day transdermal 2% testosterone gel. After a week from treatment onset, all patients underwent a total of four measurements to assess serum total T, bioavailable T and free T at +2 h (samples A and A′) and +23 h (samples B and B′). [B][COLOR=rgb(184, 49, 47)]Results [/COLOR][/B] [COLOR=rgb(147, 101, 184)][B]No significant difference was found concerning total, free and bioavailable T between the two samples taken at the same time points (A vs A′ and B vs B′).[/B][/COLOR] [COLOR=rgb(44, 130, 201)][B]A repeated-measures mixed effects regression model showed significantly lower serum levels of total, free and bioavailable T at +23 h compared to +2 h (total T, β=−3.050±0.704, p<0.001; free T, β=−85.187±22.746, p<0.001; bioavailable T, β=−1.519±0.497, p=0.003) without a significant between-sample variability. [/B][/COLOR][B][COLOR=rgb(26, 188, 156)]Serum T>3.5 ng/ml at +2 h was reached in 21/30 patients (70%), but only 11 (36.7%) still had adequate serum T at +23 h. [/COLOR][/B] [B][COLOR=rgb(184, 49, 47)]Conclusion [/COLOR] [COLOR=rgb(44, 130, 201)]Assessment of TRT with transdermal gels at its peak and at its minimum could be useful in providing a finely tailored treatment for hypogonadal men, both preventing supra-physiological levels and maintaining adequate concentrations through the day.[/COLOR][/B] [B]Conclusions [/B] [COLOR=rgb(184, 49, 47)][B]The treatment of male hypogonadism is associated with improvements in several health outcomes, ranging from sexual symptoms to metabolic profile.[/B][/COLOR] Most patients undergo TRT; transdermal testosterone gels are often preferred by patients due to their ease of use and allow for quick treatment discontinuation if needed. Monitoring of hypogonadism is necessary, as TRT should increase serum testosterone without reaching supra-physiological levels; [COLOR=rgb(44, 130, 201)][B]guidelines suggest assessing “peak” concentration, although we hypothesize that assessment of serum T at its lowest point—just before a new gel application—could be useful in assessing the correctness of the treatment dosage.[/B][/COLOR] [COLOR=rgb(26, 188, 156)][B]In the authors’ opinion, if only one measurement is feasible, the “lowest-point” measurement could be helpful in patients with no improvement despite treatment, whereas the “peak” measurement providing useful safety information remains a priority in all other patients.[/B][/COLOR] While two measurements are necessary for diagnosis, the little intra-individual variation could spare the necessity of a second measurement for subjects undergoing treatment with testosterone transdermal gels. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Monitoring testosterone replacement therapy with transdermal gel: when and how?
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